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Quality of life, and physician assisted suicide

Medical Ethics Medicine Quality of Life Assisted Suicide

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#1 Godeskian

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Posted 09 November 2005 - 01:03 PM

It's a topic we've bandied about from time to time here on Exisle, and I thought i'd share this article when it appeared on the BBC website.

http://news.bbc.co.u...lth/4420342.stm

Quote

Nora Nicolaidas is settling up.

She has put her house on the market, the childcare she performed for her daughter for the last four years has now passed to a minder, and all her bills are paid.

But it is not her home town of Portland Oregon she is settling accounts with, it's life.

Nora has advanced breast cancer - she was first diagnosed 13 years ago.

She has run through the gamut of treatments but when it spread to her bones and then recently her liver she knew she was in the endgame with the disease.

Quote

She is jaundiced from her liver disease which has turned her skin and eyes yellow and her belly is swollen from the tumours.

...

The cancer will steadily cause her liver to fail and as it does, she will struggle to eat, the pain she feels daily will increase, more and more of her bodily functions will shut down and in the end even her mind could start to fail. 

Quote

So, she argues, she is grateful she lives in Oregon and has another option.

The state is the only location in the US which permits physician assisted dying.

This is the right for terminally ill patients with just six months to live to be prescribed and to self-administer a fatal dose of barbiturates.

In this way they can choose not to endure the pain, loss of control and loss of dignity that can sometimes accompany the end of life.

"I am not scared of dying," said Nora, "I am scared of how I am going to die."

It's always interesting to me how we sit here on Exisle and bandy about theories and opinions and suggestions and worries. We talk about things with the flair and passion of people who truly believe the things they support. I know we have a fairly active pro-life crowd who consider euthanasia a bad thing.

But can anyone really read this article and tell me this woman should be forced to live out her few remaining days, her body and mind failing more day by day, just because in most of the US she would not have had the right to physician assisted suicide?

A while back someone asked me how I, as a basically moral and decent person could possibly back euthanasia. I'd like to ask people how they can see a story like this and oppose it.

#2 Themis

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Posted 09 November 2005 - 01:37 PM

Indeed.  Without euthanasia our best hope is to fall into a coma as everything is shutting down.  Costs money but not dignity.  What's good enough for beloved animals is good enough for me.

With the Oregon system, you administer it yourself...  I know we've all heard tales of medical staff giving an overdose of a medication like morphine in a hopeless case and I'm all for those people too.  The complication for people incapable of self-administration is that opportunities for abuse abound.  

The living wills this office prepares have a choice for the administration of medication to alleviate pain but not to prolong life, and everybody should have a living will.  And a power of attorney for health care if you are fortunate enough to have somebody you can delegate that power to (it doesn't have to be a relative).  

It is a very difficult subject and there should be possibilities for personal choices.

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#3 Nonny

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Posted 09 November 2005 - 02:02 PM

Quote

She ascribes the peace she has achieved with her death to her decision to use Oregon's Death with Dignity Act.

It is not about committing suicide, she argues, but about allowing her to control the manner in which she dies.
I agree that this is not suicide, this is controlling the manner of death.  

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She says all her family and friends are supporting her in this choice and it allows her to die peacefully with those she loves around her.

"This is the option for my family not to see me suffer. This is something that is my wish. I want to have a celebration for life and I will do it when I am ready."
A brave woman with a brave, caring family.  

Quote

"I choose to go happy and having this option took off the fear and the burden I had of the end coming, because that was pulling me down a lot.

"Now I am free - free to enjoy when my grandchildren come and both run on me, free to hug them.

"To see their smiles is beautiful, it's more beautiful than it was a year ago before I made this decision, its more precious now. I am for life - for good life. And good death."
When she goes, I hope she goes in peace, and rests in peace.  

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#4 Rhea

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Posted 10 November 2005 - 05:17 PM

I've always figured that people who are against any form of assisted suicide have never seen a human being die in pain you wouldn't let your dog suffer. The first year of nursing school cured me of ever wanting to watch anyone's pain prolonged.

I have a friend right now who's dying of cancer, and they stopped her dialysis several days ago and she's quietly slipping into a coma, which is the most merciful death she can hope for - there's been very little pain.  I know places, like Texas, where she probably wouldn't have been afforded this boon (I've had family members die there, and they're for prolonging suffering at maximum expense in pain, heartache and money rather than pulling the plug).

I believe the dying and their families should make these decisions and that medical professionals should be allowed to be merciful in the case of those who have no families to go down this road with them.

And I believe the state and the federal government should butt the hell out.

Edited by Rhea, 10 November 2005 - 05:51 PM.

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#5 prolog

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Posted 10 November 2005 - 07:12 PM

Godeskian, on Nov 9 2005, 06:03 PM, said:

A while back someone asked me how I, as a basically moral and decent person could possibly back euthanasia. I'd like to ask people how they can see a story like this and oppose it.

<{POST_SNAPBACK}>


For me, it comes down to this: is the person an adult?  If so, then they should be able to do just about anything to themselves that they wish.

#6 Mandi

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Posted 12 November 2005 - 10:15 PM

Being in Oregon, there has been alot of debate about this. It angers me when the religious groups pipe up and condem this woman for wanting to die. If this was my mother, i'd support her decision!
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#7 White Tiger

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Posted 14 November 2005 - 06:54 AM

Quote

I've always figured that people who are against any form of assisted suicide have never seen a human being die in pain you wouldn't let your dog suffer. The first year of nursing school cured me of ever wanting to watch anyone's pain prolonged.


EXACTLY!
I find it ironic that the ones that condemn euthanasia are never the ones dying horribly. Ironic...riiiiight.
Its seems to be about control...as with everything else. If someone wants to fight all the way through I say go ahead. If someone wants to end the pain...I say go ahead. We as outsiders should have no say over the one who should have the ultimate right of yes or no.

Edited by White Tiger, 14 November 2005 - 06:55 AM.

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#8 Smiley

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Posted 14 November 2005 - 08:33 AM

prolog, on Nov 10 2005, 06:12 PM, said:

For me, it comes down to this: is the person an adult?  If so, then they should be able to do just about anything to themselves that they wish.

<{POST_SNAPBACK}>


I 100% agree.
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#9 rponiarski

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Posted 14 November 2005 - 11:41 AM

It is a complicted issue. Having watched more people than I care to recall die, I can understand how they may want to have a say in the manner of their death. They and their families need to make the decisions and government needs to stay a long way away from this, as proved by the Terri Shiavo disaster.

On the other hand, I would not do it as a physician. I took an oath about 20 + years ago to "First, do no harm" and I plan to keep that oath. It is tough, but going down that path is a very slippery slope and I do not feel capable of walking that road without falling. And that is something I would never want to do...
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#10 Nikcara

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Posted 14 November 2005 - 11:49 AM

I can respect someone who would not wish to do it so long as they also didn't hinder a person's decision.  It is hard, both the decision that it's time to die by the patient and also by the family/loved ones.

I do not believe in forcing doctors to do something they are uncomfortable with so long as the patient can find someone who is willing.

It is a sad thing all around.
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#11 Rhea

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Posted 14 November 2005 - 02:37 PM

rponiarski, on Nov 14 2005, 08:41 AM, said:

It is a complicted issue. Having watched more people than I care to recall die, I can understand how they may want to have a say in the manner of their death. They and their families need to make the decisions and government needs to stay a long way away from this, as proved by the Terri Shiavo disaster.

On the other hand, I would not do it as a physician. I took an oath about 20 + years ago to "First, do no harm" and I plan to keep that oath. It is tough, but going down that path is a very slippery slope and I do not feel capable of walking that road without falling. And that is something I would never want to do...

<{POST_SNAPBACK}>


I respect that. I also understand that to some doctors, letting a human being die in terrible pain is doing harm to them. It seems to be personal ethics which determine how one interprets the Hippocratic oath. Some doctors do not want to let a person with no chance of recovery go no matter the pain, no matter that there is no hope of improvement. I don't understand the need to prolong suffering but I accept that many medical professionals see it that way.

Edited by Rhea, 14 November 2005 - 02:40 PM.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
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When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#12 QueenTiye

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Posted 14 November 2005 - 02:43 PM

Interesting.  I have possibly got to make such a call for my dad.  The choice is between heart surgery that may prolong his life at the (further) expense of his mental health.  I find that a very difficult decision to make, and would not envy anyone who was forced to make an end of life decision.

In the age in which we are capable of managing pain - I believe that people should be allowed to die naturally with effective pain management.  That is something far different from euthanasia.  OTOH, if someone themselves decides to euthanize themselves, I don't think we have the right to argue with them - and I think that doctors should be obliged to give patients what they need to do the job if they are in such a condition that the doctor's options for health are exhausted.  I do NOT think that doctors should be allowed to do it.  For similar reasons - I have trouble with the idea of allowing health care proxies to do it.  But - I think, given what a health care proxy is, that they should be allowed, again, if all other doctor options for health are exhausted.

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#13 Rhea

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Posted 14 November 2005 - 03:12 PM

The truth is that there have always been healers (for as long as we've had opiates to help things along) who have been willing to ease the dying out of life as painlessly as possible.

Often it's done very quietly, by simply increasing the pain meds for someone who's dying in terrible pain to a level that would technically constitute an OD, allowing them to slip away quietly and painlessly.

I would not want the decision to rest solely with families and never with doctors, because what happens to people who are indigent or have no family? Should they die in pain because there's no family to speak for them when they're helpless to speak for themselves?

In my family we all have every legal scrap of paper we need to make our wishes known and to be able to help each other. After witnessing the prolonged suffering of several family members by well-meaning medical professionals who believed in prolonging life at all costs (and I would love to debate what "life" consists of in a person who is completely senile, who can't care for themselves or recognize anyone and who was left to suffer for months from pneumonia, gurgling her life away because the medical professionals caring for her were so worried about "doing no harm" that they forced her poor body to linger on rather than allow us to have the machines turned off).

I can't help but feel that somewhere along the way we've love the concept that death is a vital part of life. I lived with my great-grandmother the summer before she died. She was old, and her body was slowly shutting down - her heart was going, she was incontinent part of the time, sometimes she called me by my grandmother's name instead of her own - but she was allowed to die with as little pain and the greatest dignity possible, in her own home.

My friend with cancer died at home Friday. While she was in the hospital she had been in unbearable pain. Once that was controlled and she got home and off dialysis, she simply slipped quietly away in her own home with her family and friends around her. Everyone should have the chance to die that way - with as little pain and as much dignity as the process allows.

Edited by Rhea, 14 November 2005 - 03:16 PM.

The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
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When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#14 QueenTiye

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Posted 14 November 2005 - 03:14 PM

Right. I would want for the doctors to SAY - all we can do now is prolong life and ease pain - but that pain will not end, and may require increasing amounts of drugs, and that health cannot be restored, and will continue to get worse.  BUT - I don't want the doctors being the ones administering the drug.  I want the person, or a person acting on that person's behalf, to have the final say in that process.

QT

#15 Mary Rose

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Posted 14 November 2005 - 04:08 PM

I'm for physician assisted suicide.  I always have been.  It is up to the person who is ill to make that call and no one else.
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#16 rponiarski

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Posted 14 November 2005 - 05:36 PM

Rhea, on Nov 14 2005, 03:37 PM, said:

I respect that. I also understand that to some doctors, letting a human being die in terrible pain is doing harm to them. It seems to be personal ethics which determine how one interprets the Hippocratic oath. Some doctors do not want to let a person with no chance of recovery go no matter the pain, no matter that there is no hope of improvement. I don't understand the need to prolong suffering but I accept that many medical professionals see it that way.

<{POST_SNAPBACK}>


I do not like to see people suffer either, and would agree with trying to make someone comfortable. My problem is when it is more than that, when it is making the decision that nothing more can be done and activiely ending a person's life.

I guess I also had it on a personal level, following the cerebral bleed my mother had. I could have prolonged her life by putting in a feeding tube, ala Terri Schiavo , but instead we placed her in hospice and she just peacefully passed on.

I really do not want the government to decide who is to live and why, just as I would never try to put my beliefs on anyone else. Grief like that is too personal...
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#17 Godeskian

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Posted 14 November 2005 - 05:48 PM

From a purely practical perspective, i've never understood the criminalisation fo both euthanasia and suicide.

I have a very rare, very old copy of one of the X-men comics, signed by the original author and the artist who drew it. Last I checked on ebay, that comic itself retailed for quite a bit, and i'm sure with the signatures it's worth more.

If I were to chuck it in the bin and set it alight, no one could legally stop me. it's my property, and barring doing harm to others I can do whatever the heck I want with what's mine.

Yet my own life isn't mine. If it was, i'd have the right to do what I wanted to with it (again barring harming others). If I want to put poison (alcohol) or drugs (pot, pills, cigarette's etc) or 300 sleeping pills into it, then it should be my concern. Not anyone elses.

Again, purely from a practical point of view, not a moral or an ethical one.

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#18 Eskaminzim

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Posted 14 November 2005 - 06:48 PM

I think this is, like many things these days, harder on the poor and those who lack good health care than it is on those who can afford it.

I have several friends with cancer, and all of them have pain medication stashed away for the time when the pain is too great, the hope is absent, and they want to deal out their hand of life.  Cancer centers, good ones, anyway, are much freer with their pain medication these days, especially to those they consider terminal.  They're not worried about addiction--which used to be a big problem before people realized--"Hey, these people are DYING!  In AGONY!  Who CARES if they're addicted to their pain meds?  It's not as if they're gonna go out selling em on the street or something!  Give them what they need".

I've got friends on Duragesic patches with both time released and regular Morphine for breakthru pain, plus enough Xanax and/or Ativan (anti anxiety medications) to euthanize a family of elephants, and it's stashed away against the time that they just can't deal with the agony anymore, and their doctors have given them no hope.

Are the doctors involved aware of the medication they're prescribing being used this way?  I'm sure they are, but keeping a terminal patient as pain free as possible is their ultimate goal, so it's really a six of one proposition.

#19 Rhea

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Posted 14 November 2005 - 06:50 PM

rponiarski, on Nov 14 2005, 02:36 PM, said:

Rhea, on Nov 14 2005, 03:37 PM, said:

I respect that. I also understand that to some doctors, letting a human being die in terrible pain is doing harm to them. It seems to be personal ethics which determine how one interprets the Hippocratic oath. Some doctors do not want to let a person with no chance of recovery go no matter the pain, no matter that there is no hope of improvement. I don't understand the need to prolong suffering but I accept that many medical professionals see it that way.

<{POST_SNAPBACK}>


I do not like to see people suffer either, and would agree with trying to make someone comfortable. My problem is when it is more than that, when it is making the decision that nothing more can be done and activiely ending a person's life.

I guess I also had it on a personal level, following the cerebral bleed my mother had. I could have prolonged her life by putting in a feeding tube, ala Terri Schiavo , but instead we placed her in hospice and she just peacefully passed on.

I really do not want the government to decide who is to live and why, just as I would never try to put my beliefs on anyone else. Grief like that is too personal...

<{POST_SNAPBACK}>


Agreed. Absolutely. And some times even with the best will you can't figure out what's right. I had a friend whose brother was injured in a high school football game - big bleed. They fought like hell to save him, even when there was a time where it looked like it would have made sense to just turn the machines off and let him go peacefully. And it took years of rehab for him to have any semblance of a life. And the awful thing is, it was all for nothing, because he could remember being the other self, but he couldn't do any of the things his other self could do. He lived in terrible anguish and he ultimately killed himself.

I sometimes wonder whether, with all of our technology, our ability to keep people alive past their time hasn't far outstripped our wisdom.
The future is better than the past. Despite the crepehangers, romanticists, and anti-intellectuals, the world steadily grows better because the human mind, applying itself to environment, makes it better. With hands...with tools...with horse sense and science and engineering.
- Robert A. Heinlein

When I don’t understand, I have an unbearable itch to know why. - RAH


Everything is theoretically impossible, until it is done. One could write a history of science in reverse by assembling the solemn pronouncements of highest authority about what could not be done and could never happen.  - RAH

#20 Shalamar

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Posted 14 November 2005 - 08:26 PM

Quote

I sometimes wonder whether, with all of our technology, our ability to keep people alive past their time hasn't far outstripped our wisdom.

Agreed

All too often people put those they claim to love through sheer and utter agony for their own selfishness, putting their wants and wishes before those they supposedly love. They do things to their loved one that they wouldn't do to an animal and pat themselves on the back for how much they 'love'.
The three most important R's
Respect for One's Self / Respect for Others / Responsibility for One's Words & Actions.

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